At first glance, the e-cigarette could seem like a cleaner, safer alternative for smokers looking to avoid the nasty risks that come with the real thing.

But experts say swapping smoking a regular cigarette for inhaling the vapor from the electronic version doesn’t exactly clear the air — or help people kick the habit. Amid increasing concerns about the potential for poisoning and uncertain findings on the toxins inhaled by e-cigarette users, doctors say one thing is clear: the e-cigarette trend isn’t making us healthier.

What Are E-Cigarettes?

Designed to look and feel like regular cigarettes, e-cigarettes are a smoke-free, tobacco-free means of delivering nicotine through vaporization. E-cigarettes contain a cartridge of liquid nicotine that is packaged with liquid vegetable fat and flavoring. The device’s built-in batteries heat the liquid nicotine, turning it into vapor that is inhaled by the user. (That is why smoking e-cigarettes is often called “vaping.”) Though they’ve been around for more than a decade, e-cigarettes have become increasingly popular in the U.S. over the last few years, with estimated annual revenue well north of $1 billion in 2013, according to Forbes.

A Move to Regulate

In a seeming admission of the health risks posed by e-cigarettes, on April 24, 2014, the Food and Drug Administration (FDA) proposed new rules to regulate the manufacture and sale of e-cigarettes, along with cigars and pipe tobacco, which, until now, have remained unregulated despite tight controls on tobacco cigarettes.

The proposed regulations, which face fierce lobbying opposition and still could be changed before being approved and implemented — a process that could take months to a year or longer — would ban the sale of e-cigarettes to individuals younger than 18 and would require buyers to provide proof of age with a valid photo ID, including for internet sales.

Because they don’t contain tobacco, e-cigarettes aren’t subject to regulation by federal tobacco laws and therefore don’t require proof of age to be purchased. Currently more than two-dozen states have banned the sale of e-cigarettes to minors, though children and teens can easily circumvent that by purchasing them online.

The FDA’s proposal also includes oversight of the manufacture of e-cigarettes, requiring “producers of cigars and e-cigarettes to register with the FDA, provide the agency with a detailed accounting of their products’ ingredients and disclose their manufacturing processes and scientific data,” according to the New York Times. “Producers would also be subject to FDA inspections,” the article states.

E-Toxins

While doctors are quick to say that inhaling the vapor generated by e-cigarettes isn’t good for you, they do acknowledge that it contains fewer chemicals than you’d find in a typical cigarette.

Stanton Glantz, MD, the director of the Center for Tobacco Control, Research and Education at the University of California, San Francisco, said that’s because of the way those toxic chemicals get to your lungs. When a cigarette burns, it creates an aerosol of ultrafine particles that carries nicotine through a person’s airway into the lungs where it gets absorbed into the bloodstream. That process creates more than 7,000 chemicals — including 69 known to cause cancer, according to the American Lung Association. The lineup includes arsenic, carbon monoxide, formaldehyde, lead and tar.

Heating up an e-cigarette, on the other hand doesn’t require the combustion that gets a regular cigarette burning. “Overall, you’re getting much less bad stuff,” he said.

How much, however, is up for debate. Dr. Glantz said e-cigarette enthusiasts might claim that the percent of toxins you breathe in is just a single-digit percent of what you get from typical smoking — but he believes it’s considerably higher.

Still a Risk for Others

Plus, e-cigarettes don’t remove the risk of secondhand exposure to others who happen to be nearby. Even without smoke, the chemicals in the vapor emitted by e-cigarettes can amount to a harmful irritant.

“If I had asthma or allergies, being exposed to that vapor could potentially cause me some harm,” said Daniel Neides, MD, medical director of Wellness Institute at the Cleveland Clinic.

Dr. Neides said his institution — and an increasing number of others — treat e-cigarette use just like any other form of smoking: smoking e-cigarettes is banned anywhere smoking is banned because of the risk to others.

A Gateway Cigarette?

As researchers try to pin down the specifics of both firsthand and secondhand risks, Dr. Glantz said the biggest hazard is already clear.

“The real issue with these cigarettes, the real health effect, is they keep people smoking regular cigarettes,” he said.

In fact, Dr. Glantz said, studies aimed at figuring out how well e-cigarettes work as a tool to help people quit smoking have shown that there’s actually a negative association. In other words, people who take up e-cigarettes are actually less likely to have stopped smoking after a year, when compared to those who didn’t dabble with e-cigarettes.

Dr. Neides said he’s particularly troubled with the marketing tactics used by makers of e-cigarettes. With flavors like bubble gum and Captain Crunch, he said it’s clear the companies are going after a specific market: young people.

While the federal government now bans companies from making flavored cigarettes because of their marketability to children and teenagers, it doesn’t have as much reach over the e-cigarette market. And the proposed regulation by the FDA does not address flavored e-cigarettes, a point of much criticism by e-cigarette opponents.

Dr. Neides believes it’s crucial to turn kids off to the idea of e-cigarettes before those products turn them on to smoking.

“(Cigarette companies) are directly marketing to young children as a means to get them from e-cigarettes to regular cigarettes,” he said. “Period.”

The Poison Risk

Lack of regulatory oversight has a number of major health organizations worried for another reason: A growing number of reports of poisonings related to accidental ingestion of the liquid in e-cigarettes.

Recently, a group that included the American Cancer Society, American Lung Association and the Campaign for Tobacco-Free Kids sent a letter to the White House pushing for FDA oversight of e-cigarettes.

In their letter, the organizations point to new data from the National Poison Data System that shows the rate of “e-liquid” poisonings tripling between 2012 and 2013. The Centers for Disease Control and Prevention recently reported that calls to poison centers for e-cigarette exposure poisonings is climbing steadily — from one call in September 2010 to more than 200 in February 2014.

Meanwhile, the American Lung Association noted that e-cigarette containers aren’t marked with poison symbols. Instead, the group said, they’re often labeled with pictures of fruits and smell like fruits — creating big risks for curious kids.

The group said poison centers reported that about half of all calls about e-cigarette poisoning involved a child under the age of six.

Published April 28, 2014.

Erin Golden is a writer based in Nebraska. She is a graduate of Northwestern University’s Medill School of Journalism.

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